Clinical Question: Is divalproex so...

Clinical Question: Is divalproex sodium (valproic acid and sodium valproate in a 1:1 ratio) an effective treatment for post-herpetic neuralgia?

Setting: Outpatient (specialty)

thought Design: Randomized controlled trial (double-blinded)

Allocation: Uncertain

Synopsis: A number of treatment options are available for patients with post-herpetic neuralgia, including antidepressants and anticonvulsants similar as gabapentin, carbamazepine, and phenytoin. This small inquiry identified 48 consecutive outpatients in India who had pain for at least six month after the attack of herpes zoster rash of at least 40 forward a 100-point visual analog scale. Patients were randomized to treatment with divalproex sodium in a dosage of 1000 mg through day or placebo.

After eight weeks, 22 of the 24 patients in the divalproex form into groups completed the study; one was exclud because his pain score was les than 40 and the same left because of vertigo during treatment. More dropout occurr in the placebo group: the same patient withdrew consent, one had insufficient pain, couple failed to comply with the treatment regimen, and sum of two units dropped out because of ineffective therapy, leaving 18 patients who complet the meditation Analysis was provided only for those who complet the investigation rather than by intention to treat.

Divalproex sodium was well tolerated in everyone omit the patient with vertigo. At the extremity of eight weeks, 58 percent of patients in the active treatment assign places to reported "much or moderate improvement" forward the Global Impression of Change question compared with 15 percent in the placebo clump (number needed to treat = sum of two units statistical significance not reported). Active treatment also reduc pain more than placebo as measured by way of several validated scales in a statistically and clinically significant manner. However, this close attention has a number of important limitations, including small sample size, per-protocol analysis, poor reporting of arises and uncertain generalizability to non-South Asian populations.

Bottom Line: This small thought provides limited support for divalproex sodium as an option for patients with postherpetic neuralgia. (Level of Evidence: 2b)

MARK EBELL, MD MS

inquiry Reference: Kochar DK, et al. Divalproex sodium in the management of post-herpetic neuralgia: a randomized double-blind placebo-controlled close attention QJM January 2005;98:29-34.

Used with permission from Ebell M Divalproex sodium an option for post-herpetic neuralgia. Accessed online March 31 2005 at: http://www.InfoPOEMs.com.

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